Publix Pharmacy

Primary specialty

PharmacistTaxonomy code 183500000X

License

0013197 Issued in GA

Legal business name

PUBLIX PHARMACY

Practice address

1109 S Park St
Carrollton, GA 30117-4462

Phone

(770) 214-3146

NPI assigned

Jul 29, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brenda Keller

Title

Pharmacist

Phone

(561) 312-3708

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438128000000",
    "number": "1013392281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 JOHN GORDON PL",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301167574",
            "telephone_number": "561-312-3718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 S PARK ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174462",
            "telephone_number": "770-214-3146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIX PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-29",
        "last_updated": "2015-07-29",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "561-312-3708"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "0013197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA PHARMACIST LICENSE NUMBER",
            "identifier": "RPH0013197",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Primary Care Group of West Georgia
• Kimberly Ann Prince Korobov, MA, M.DIV, LPC, NCC
• Elizabeth Morris Prince, ED.S.
• Maxine Prince
• Professional Park Medical Services, P.C.
• Publix Super Markets Inc (Publix Pharmacy #0608)
• Yuesheng Qu, M.D.
• Loralye Queen, M.ED CF-SLP
• Bryan Quinn, MD
• R&R Group Home

• Pharmacist in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.